Section 164.134 - Staffing Pattern(A) The Licensed or Approved Provider shall designate a Medical Director who shall be responsible for administering all medical services performed by the program. The Medical Director shall have documented clinical experience with opioid-dependent, alcohol, and other drug-dependent persons or 40 hours of documented continuing education credit in addiction medicine and medications for treatment of addiction, including all FDA-approved medications for treatment of opioid use disorder. The Medical Director shall be responsible for: (1) Ensuring that each patient receives a medical evaluation, including a medical history;(2) Ensuring that appropriate laboratory studies have been performed; and(3) Establishing an individualized signs of life check protocol for each patient to be documented in the medical record.(B) In addition to the staffing requirements of 105 CMR 164.048, the Licensed or Approved Provider shall establish a staffing pattern in sufficient numbers and positions necessary for the service type provided. Any program which serves persons who identify as male or female must have a plan in place for ensuring at least one direct care staff person on-site who identifies as female and one direct care staff person who identifies as male on each overnight shift. Staffing pattern shall include the following positions: (1) A full-time equivalent Senior Clinician among direct service staff who shall be responsible for the clinical/educational operation of the substance use disorder service;(2) Licensed psychiatrist or licensed psychologist on staff or available through QSOAs;(3) Registered nurse, advanced practice registered nurse, or physician assistant;(4) Licensed practical nurse, case aides and case management staff;(5) If serving pregnant women, an obstetrician/gynecologist available on staff or through a QSOA;(6) Food personnel trained in safe and sanitary food handling and preparation, as specified in 105 CMR 590.000: Minimum Sanitation Standards for Food Establishments and 150 CMR 590.003: Management and Personnel. Food service permits, where required, shall be current and available for review by Department personnel; and(7) Sufficient staff coverage on all shifts to ensure patient needs are met. Such staffing shall include the following staffing minimums, which shall be adjusted upward in order to address patient acuity and programmatic need: (a) Licensed nursing staff shall be on-site for a minimum of eight hours per shift, provided that each day and evening shift includes at least one registered nurse seven days per week;(b) The Provider must provide a minimum one recovery specialist for all shifts, seven days per week; and(c) The Provider must provide at least two case managers providing services over a 12-hour time period, seven days per week.(8) Any Provider who treats patients younger than 18 years old must have a Case Manager on staff and provide sufficient staff coverage on all shifts to ensure patient needs are met. Such staffing shall include the following staffing minimums, which shall be adjusted upward in order to address patient acuity and programmatic need: (a) A minimum of one full-time registered nurse responsible for supervision of all nursing staff, or a Licensed Practical Nurse (LPN) or other Qualified Health Care Professional provider defined under 105 CMR 164.005 who possesses the skills and supervision experience as determined by program and/or meets the requirements under professional licensure; provided, however that the supervisor shall be educationally prepared at or above the level of the nursing staff under his or her supervision;(b) A minimum of one full-time recovery specialist for all shifts;(c) Case manager staffing such that there is a minimum of eight hours of case management services provided at least five days per week;(d) Counselors on-site for a minimum of 12 hours per day, seven days per week; and(e) One full-time Clinical Director that meets the definition of a Senior Clinician on-site a minimum of five days per week to provide supervision and oversight of the provision of clinical services.(C)Clinical Supervision. In addition to supervision requirements set forth in 105 CMR 164.044, the Licensed or Approved Provider shall ensure that supervision of nursing staff is overseen by a Practitioner, a registered nurse, or a Licensed Practical Nurse (LPN) or other Qualified Health Care Professional provider defined under 105 CMR 164.005 who possesses the skills and supervision experience as determined by program and/or meets the requirements under professional licensure; provided, however that the supervisor shall be educationally prepared at or above the level of the nursing staff under his or her supervision.(D) The Licensed or Approved Provider shall ensure a qualified Practitioner is available 24 hours per day, seven days per week, on site, through a QSOA, or by the use of telemedicine as appropriate and in the discretion of the Practitioner, to provide consultation to staff. If services are to be available through an agreement, this agreement shall be reaffirmed at minimum every five years.Amended by Mass Register Issue 1482, eff. 11/11/2022.